| Sir Graham 'Mont' Liggins obituary Pioneer of life-saving lung treatment for premature babiesGraham "Mont" Liggins, who has died aged 84, developed a life-saving treatment for premature babies, after showing that foetal lung maturation could be speeded up by administering a steroid. This gave babies born with lungs that were not functioning properly a chance to breathe and survive. His research changed medical practice and saved hundreds of thousands of lives.Mont used to tell the story of his farming neighbour, knowing he was an obstetrician, asking why lambs so often die after premature delivery when dogs worry the ewes. Mont did not know, but he realised the question mattered and he wondered if it might have something to do with the stress-response steroid cortisol. He tested his hypothesis in a series of experiments and eventually proved that, at least in sheep, foetal cortisol release triggers labour.This was important, but he had also noticed something else. The lungs of premature lambs normally sank in water because they had failed to fill with air. However, if the ewe had been given corticosteroids prior to delivery, the lungs inflated normally and floated – the steroids had stimulated production of a soapy substance, surfactant, which was vital for lung aeration. Premature human babies also lack surfactant, and can develop a frequently fatal condition known as respiratory distress syndrome (RDS). Over the next few years Mont and Ross Howie, a paediatrician colleague, randomly allocated steroids or placebos to more than 1,000 women in premature labour. Both RDS and mortality fell dramatically in the experimental group, and that simple treatment now saves the lives of many thousands of premature babies.Mont was born in Thames, on New Zealand's North Island, the fourth son of a doctor. His nickname arose from his childhood infatuation with the cartoon character Monty the Mouse. From 1944 to 1948 he studied medicine in Dunedin, on South Island, where he later worked as a GP to save up enough money to travel to Britain for specialist training. He met his wife, Celia, later Auckland's first female obstetrician, in Newcastle upon Tyne and together they worked for a short time in Cumbria, where Mont claimed to have regularly swum in the sea off the Windscale nuclear power plant. Celia blamed radioactive waste for the lymphoma he developed many years later.In 1959, he returned to New Zealand as a consultant at the National Women's hospital, in Auckland, where he met Bill Liley, the obstetrician who later performed the world's first intrauterine transfusion for rhesus disease, who suggested preterm labour as a topic for study. After minor projects on fertility treatment, Mont developed his experimental techniques, in particular his methods for studying the physiology of lambs in utero. He later refined them after visiting the University of Davis, California, and the Nuffield Institute for Medical Research at Oxford, run by Geoffrey Dawes.A natural outdoorsman, Mont epitomised the Kiwi "No 8 wire man" mentality: someone who can fix anything with whatever is to hand. For the next 30 years he combined clinical practice with animal physiology performed in his laboratory, a small wooden hut in the hospital grounds, and with Dawes led the science of foetal physiology.Mont was a scrupulously honest researcher. In California he blew the whistle, at some risk to his own career prospects, when he discovered a colleague fabricating data. When his steroid discovery paper was praised for the careful trial design he always acknowledged his debt to Howie. His treatment was not accepted overnight, though. The first report, in the journal Pediatrics in 1972, is now a citation classic but, incredibly, the Lancet had rejected it on the grounds that it would be of little general interest. Perhaps an obstetrician had reviewed it – obstetricians were certainly reluctant to implement it. They argued that other, smaller, studies had shown no benefit. Mont probably suspected that they were reluctant to advocate a treatment developed in a small faraway country such as New Zealand.Clinical obstetrics was in poor health at the time – in 1979, the evidence-based medicine pioneer Archie Cochrane awarded the specialty the wooden spoon for the worst use of randomised trials in all of medicine, and it took nearly 20 years before everyone realised that Mont had been right all along. Steroids work in all premature babies, and cost a few pence. The systematic review that finally pulled together all the evidence relating to their effectiveness is now a classic in its own right, and even forms the basis of the logo of the Cochrane Collaboration, the worldwide evidence-based medicine organisation.He was professor of obstetrics and gynaecological endocrinology at the University of Auckland from 1968. When, in 2001, the university established the first major research institute dedicated to developmental research, it was named the Liggins Institute. He was elected a fellow of the Royal Society in 1980, appointed CBE in 1983 and knighted in 1991. He retired from clinical practice and from his chair in 1987, but never from his "No 8 wire man" role; shortly before his death, he had rigged up a solar panel to run a watering system for his vegetable patch.Celia and a son, Graham, predeceased him. He is survived by one son, two daughters, and several grandchildren.• Graham "Mont" Collingwood Liggins, physiologist, born 24 June 1926; died 25 August 2010• This article was amended on 7 September 2010. The original stated that Sir Graham "Mont" Liggins is survived by two sons and two daughters.Premature birthMedical researchNew Zealandguardian.co.uk © Guardian News & Media Limited 2010 | Use of this content is subject to our Terms & Conditions | More Feeds guardian.co.uk |
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